title: Donor-site morbidity of free fibula and DCIA flaps.
abstract: OBJECTIVE
  This study evaluated and compared the long-term donor-site morbidity of the free fibula flap with the deep circumflex iliac artery (DCIA) flap in maxillofacial reconstruction.
  
  
  METHODS
  Thirty-four patients (19 in the fibula group and 15 in the DCIA group) were evaluated for long-term morbidity. All clinical data were analyzed, including primary disease, type of defect, type of flap, length of bone harvested, total blood loss, operating time, length of hospitalization, and postoperative unaided gait. Subjective evaluation included cosmesis, function, and pain. Objective evaluation included physical examination, neurosensory assessment, Stony Brook Scar Evaluation, gait assessment, and goniometric measurement of range of movement.
  
  
  RESULTS
  In the subjective evaluation, no significant differences in cosmetic outcome, functional loss, wound healing, or pain between the 2 groups were noted (P > .05). However, neurosensory deficit was worse in the DCIA group (P ≤ .05). In the objective evaluation, 4 patients (27%) in the DCIA group had neurosensory deficit in the lateral thigh region. The DCIA group had a better Stony Brook Scar score (median, 5) than the fibula group (median, 4; P ≤ .05). However, there was no difference in walking ability between the 2 groups (P > .05). Goniometric measurement showed a significant difference between the operated and unoperated sites in the 2 groups; however, it was not severe enough in either group to affect patients' function. In the fibula group, 7 patients (38.9%) had claw toe deformity and 2 patients (12.1%) had weakness of the great toe, and the mean American Orthopedic Foot and Ankle Society score was 96.89. In the DCIA group, 1 patient (8.3%) had a hernia and the mean Harris Hip score was 98.33.
  
  
  CONCLUSIONS
  Given that these 2 options present donor-site concerns, the authors consider the fibula free flap the first choice for maxillofacial reconstruction in most cases and the DCIA free flap a reliable complementary flap in selected patients.
authors.affiliation: Oral Surgery, Hospital Kulim, Ministry of Health, Kedah, Malaysia.
authors.forename: Xiao Feng
authors.initials: XF
authors.lastname: Ling
authors.forename: Xin
authors.initials: X
authors.lastname: Peng
authors.forename: Nabil
authors.initials: N
authors.lastname: Samman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D016063:Blood Loss, Surgical; D002648:Child; D002921:Cicatrix / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000601:surgery* / Q000637:transplantation; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology; D058752:Free Tissue Flaps / Q000473:pathology* / Q000601:surgery; D005684:Gait / Q000502:physiology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007083:Iliac Artery / Q000601:surgery* / Q000637:transplantation; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site / Q000473:pathology*; D055815:Young Adult